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Here’s a scenario most of us have experienced in some form. It’s the middle of the night and the phone rings. It’s your son in Seattle calling to tell you his 70- year old father-in-law took a fall and he’s with him in a hospital emergency room. He has a fracture—or did he say “fractures”—plural. Or maybe it’s an early morning call; your 80-something sister in Florida is calling; she just received a diagnosis that will keep her homebound–maybe even bedbound–for months.
Those calls are “911 look-alikes.” You’re not the one in crisis, but the family member at the other end of the line is dealing with an emergency and wants/needs your assistance. Even if you have been fortunate enough to avoid any kind of personal health crisis or life-changing accident, someone else’s 911 situation is about to impact you. Be ready—use that moment well.
You are a good and caring person, of course, and you will provide gentle counsel and offer information and resources appropriate to their emergent situation. Maybe you’ll do follow-up calls or make a cross-country visit to the individuals(s) in distress. You’ll probably send a get-well card or flowers. Maybe you’ll use the internet to assemble ideas that address “their” issues. And then, quite probably, time will pass and you will move on to the other things in your life. Opportunity lost.
“Opportunity,” you say? “Yes,” I reply.
Here’s how I see it. As older adults, we are in active denial–about “being old” of course, but also about the likelihood we’ll have a debilitating fall or be diagnosed with a medical condition that displaces us from our circle of comfort. According to aging expert, Dr. Mary Doheny, we are unwilling to talk about aging “until something really traumatic happens to us like the death of a spouse, the illness of a partner or the need for hip or knee replacement.” And at that point, “denial often turns to despair” and any ability to make informed choices is reduced—dramatically.
Denial does not work. Aging keeps happening. And many people do not have a strategy for dealing with that reality. When a “911 look-alike” occurs—maybe we should use that moment as a reminder to develop that strategy. Here’s why. The Federal Commission on Long-Term Care indicates “70% of us who live beyond the age of 75 will need some sort of caregiving, on average for three years.” Do you have a plan for that?
Perhaps, as are many, you’re “counting on family members to provide any needed caregiving” But are you talking to them about your care preferences?” This is not a conversation about death and dying—this is a conversation about “defining how you want to ‘live,’ despite changing health needs and the daily physical struggles that emerge as you age.“
Maybe you won’t need a middle of the night call to ignite your interest in developing a personal long-term care strategy. Maybe this information will do it. I like to think it will, at minimum, prompt more conversation. Prove me right?
Excerpted from 2014 Mail Tribune column.

The front page feature in today’s Mail Tribune was an article on Medford’s plans to expand their urban growth boundary to accommodate anticipated population growth over the next 20 years. Having spent five years on the Jacksonville Planning Commission I am familiar with the process (and have the scars to prove it). This expansion is expected to result in the construction of 15,000 new homes.

What is unsettling to me after reading the article was that there is no mention of accessibility in the article and indeed the city planners apparently do not take that under consideration. The criteria used to score properties under consideration to expand Medford’s boundaries are: transportation, affordability, environmental, infrastructure, required density, neighborhood integration and housing diversity. The final criterion, housing diversity, potentially offers an opportunity to plead my case for accessibility.

Last year Harvard University’s Joint Center for Housing Studies published a report titled “Housing America’s Older Adults, Meeting the Needs of an Aging Population.” The report stated very clearly “affordable, accessible, and well-located housing is central to the quality of life for people of all ages, but especially older adults. Accessibility is essential to older adults’ health and safety as physical and cognitive limitations increase. But the existing U.S. housing stock is unprepared to meet the escalating need for affordability, accessibility, social connectivity and supportive services.”

Will Medford allow 15,000 new homes to be built without attention to accessibility? Who will purchase these new homes? By 2020, according to census projections, 23.2% of Jackson County residents will be over age 65. Medford has long been a retirement Mecca of sorts, drawing Californians to our Valley. Will these retirees find accessible homes they can “age-in-place?”

The Harvard study states that the five most important “universal design” features in a home are: no-step entries, extra-wide hallways, accessible living spaces on the ground floor and accessible light switches and door levers. According to the study only one percent of the housing units in America have all five of these features. Today with a few notable exceptions, most developers are still building homes without these necessary universal design features. Are we going to allow development of homes for the future or the past?

One additional item from the Harvard report should give us all pause. They cite the disconnect between housing programs and health care systems which put older adults with disabilities or long-term car needs at risk of “premature institutionalization.” Put simply this means that if a homeowner develops a health issue or suffers a major injury, say from a fall, it is possible that person will not be able to stay in their own home because it lacks accessibility.

There is a solution to this issue. The planners in all major Southern Oregon cities (indeed throughout the country) should adopt as part of their criteria for scoring properties the first level of the Rogue Valley Council of Governments” Lifelong Housing Certification Standard. This first of three levels of certification requires that homes be “visitable” for all guests. This means a person in a wheel chair can easily access the main entertainment area of the home including a hallway with sufficient width leading to an accessible bathroom.

If you want to see what these homes look like drive out to the Twin Creeks Development in Central Point and follow N. Haskell St. to the Age-Friendly Homes sign. The future is now.

Later today we’re having a dinner party for twenty people. You may wonder what I’m doing blogging at this moment in light of the various preparations needed for an event of that kind. The answer would be “guilt”—because I have not blogged recently. Another good answer to that question is, “Having guests in your home involves more than turning on the BBQ, making a delicious pasta salad and getting the silverware and napkins readied.” It involves ‘thinking around the corner’ regarding your home environment.

For example– this occasion is the birthday party for a ninety-two year old gem of a man and many of his/our guests will have mobility issues. So the pathway to our home really needs to be “older-generation friendly.” No obstacles or objects in the way. No wobbly railings. No slippery sidewalks. Check.

The guests arrive in daylight but will leave after dark, so we have assured that walkways are well lit. Very well lit. Inside our home, we do not have scatter rugs of any kind because we know the fall-risk attached to them, but if we did– we would be vigilant in removing them or securing them tightly with double-scaled carpet tape. Seating for these guests is particularly important. It should be “appropriately firm, high in the seat and, preferably have arms,” according to a recent article from the National Association of Home Builders. More ”Tips for Elderly Visitor Safety” are available at www.nahb.org Check…it out.

You might also look at the Age Friendly Innovators (www.agefriendlyinnovators.org) website and its companion Facebook page for more of this kind of information. “Like”" on Facebook if you will. My husband hosts that site and he just passed 100 “likes” on all his various postings over the past six months. When we get to 200 “likes” we plan to have have another dinner party. The guest list is already being developed. Let us know if you are available. Check!

I woke up this morning thinking about dying. No, I didn’t “think” I was dying, just thinking about the subject in general. I’m not hung up on the subject and am in great health (thanks in no small measure to my dear and caring wife) but recently I came across three articles about dying. Before I share these articles let me say at the outset that I don’t know when I will die and I don’t know how I will die….but I do know where I intend to die. More about that later.

The first piece was an essay in the New York Times titled “My Own Life” written by famed 81 year old neurologist Oliver Sacks. Dr. Sacks announced in his essay that his cancer from some years back had returned and metastasized into his liver leaving him with just months to live. I cannot hope to condense his words into a paragraph and do him justice so I will pick a few sentences. Sacks wrote “over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life, on the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.”

The second item on dying was a review of a new book titled “The Age of Dignity” by Al-Jen Poo. the book is subtitled “Preparing for the Elder Boom in a Changing America.” She writes about her experience with her grandfather and his death in a multi-bed nursing home room shared “with six other people, half of whom were completely silent, while the other half expressed their misery in loud, painful, cries. The room lights were kept off, while a sickly fluorescent light in the hallway flickered. The place smelled like mold and death. It was my heart-wrenching introduction to dehumanizing institutional care” she writes. Al-Jen Poo’s book is a wake-up call to America where 10,000 people are turning 65 each day and will continue to do so for the next 19 years. Where will the caregivers come from and how and where will these tens of millions live out their lives. I’ve ordered the book and will share more in a later blog.

The final items was an article in the Mail Tribune this morning regarding a series of presentations on death and dying titled “Facing Mortality: The Elephant in the Room.” The presentations are sponsored by Choosing Options, Honoring Options (COHO) and the next presentation on February 26 is a play based on the story of a brilliant scholar battling ovarian cancer. This will be followed on March 12 with a discussion on “choosing levels of late-in-life treatment.” On March 19 there will be a theatrical presentation called “Mom, Not at Thanksgiving!” about trying to have a conversation about dying. The final session in the series will be on April 16 on creating advanced directives. Pre-registration is required at http://cohoroguevalley.org or by calling 541-292-6466. All presentations are free and will be held at the Asante Smullin Center. A $10 donation is suggested.

As I said at the beginning, I don’t know when I will die. I don’t know how I will die. What I do know is that, if I become incapacitated, I can die in my own home, perhaps in what is now my office, looking out the window at the glorious foothills to the West of the Valley and my wife by my side. Through careful planning we have created a home environment that is, well, to die for. It’s never too early to begin thinking about end of life planning.

We are aging. It’s what we do. May I suggest we also do this. Let’s identify and start to use practical ideas and products that enhance our independent living. After all, independence in later life is what we all aspire to, is it not? So, let’s take a look at what’s out there for easy purchase to help us achieve greater ease of living.

This is “our” list, age peers, take a look. I’m about to order a wireless key/object finder that will make my life better—immediately. That and the hooks we installed by the door to the garage on which to hang our keys. The one I intend to paint red is “my” hook. I think I have the “I cannot find my keys” issue almost fully addressed, but keys are not the only objects I seem to frequently misplace.

We have a lot to remember as we get older and anything we can do to enhance our memory ability is added benefit to ease of living. Our lives are likely to continue 15-25 years beyond the historically subscribed-in-stone retirement age of 65. And the experts suggest that none of us want to “go on vacation” for decades. There will be things we want and need to do–and some of them (see above) will need a little assistance. I’m not suggesting you purchase a barrier-free walk-in bathtub and shower or a new side-by-side self-defrosting refrigerator but that object/key finder is a must-buy. At least for me.

Surveys clearly indicate older adults want to stay in their current home and community as they age. However, for a variety of reasons, many over-50 households make the decision to either build a new home or purchase another, often smaller, home. Typically the reasons given for moving are after the children leave the home (empty nesters); the desire to be closer to children and grandchildren and the opportunity to sell and extract equity then downsizing to a smaller home.

One reason not often considered is whether the current home will meet the occupants’ needs and they age. What happens if health conditions change and they develop mobility issues including the need for walkers or wheelchairs. When Sharon and I made the decision to leave our two-story Victorian style home in Jacksonville it was the realization that the home simply could not be renovated to provide greater accessibility. Based upon our experience, I would suggest the following “must haves” you should consider when looking for another home:

Single story – A single story home is not only easier to maintain, but it also provides greater mobility. If a two-story is the only option, make certain the master bedroom is on the first floor.

Barrier-free entryway – Multiple steps can present a significant barrier to home entry for occupants and visitors alike. When looking at homes consider what would be required to have at least one no-step access point in the home. Often a small number of front steps can be rebuilt as a sloping walkway to eliminate steps and provide smooth entry for all – mothers pushing baby carriages to those in wheelchairs. For each inch of steps a foot of slope is required. Thus two 6 inch steps would require 12 feet of sloped approach (ramp or concrete).

Wider doors and hallways – Most homes built today have at least the minimum 32 inch entry width, with a 36 inch width optimum. All doors in the home should meet these dimensions. Hallways should be at least 36 inches wide with 40 inches or more ideal.

Accessible bathroom – The home should have at least one accessible bathroom for occupants or visitors. Remodeling a bathroom for access is often one of the most costly renovations. For a full bath, a 9 foot by 7 foot space would be the minimum size and could be configured to provide a 60 inch by 36 inch open space for maneuverability. A raised (comfort) height toilet 17 to 19 inches from floor to rim and an “aging-in-place” shower surround should also be included. Having a pedestal style sink instead of a vanity provides additional floor clearance. Finally, stylish grab bars are highly recommended and a pocket door or door that opens out would be needed to gain the interior space.

Hand-friendly hardware – Levered door handles (instead of knobs), rocker light switches (instead of toggle) and loop-style or D-shaped cabinet pulls make opening easier for those with arthritic hands. Easy-open window hardware should also be considered. A window you can open or close with a closed fist.

There are many other features that will complement the “must haves” listed above including increased lighting, kitchen appliances with controls in front, non-slip floor surfaces, raised washer and dryer and motion-activated light switches.

While buyers may not find all these “must haves” in the home of their choice they can make informed decisions as to how much it would cost to have these features installed.

Incorporating these “must haves” into the home buying equation means you will be getting a home that “lasts a lifetime.”

Carrying out the mission of our nonprofit organization, Age-Friendly Innovators, includes a great deal of market research. This means looking at the demographics of aging, future housing needs of older adults and wading through a number of research papers and reports.

Recently, I came across a 61-page 2014 report titled “Best Cities for Successful Aging.” The report was produced by the Milken Institute, an independent economic think tank, whose mission is to improve the lives and economic conditions of people in the U.S. and around the world. The report can be found at www.milkeninstitute.org. The report is a subset of a larger report titled “Best Cities.”

The report introduction states “two important, unassailable facts underpin our 2014 “Best Cities for Successful Aging™” report. Our nation is aging at an unprecedented rate, in a titanic shift that is creating the largest older population in history; and these mature adults live predominantly in urban settings. A product of lower birth rates and increasing longevity, this phenomenon is changing the landscape of the United States and the world.”

The report ranks the 100 largest metropolitan areas in the U.S. and 252 smaller metro areas in the following categories: general (which includes 7 indicators such as cost of living, crime rate, weather, over 65 employment), health care, wellness, financial, living arrangements, employment/education, transportation and community engagement.

I was surprised and disappointed to see that Medford ranked 194th out of 252 small metropolitan areas surveyed. Medford had an overall score of 76.42 compared to the top small metro, Iowa City, IA, which scored 100. Individual metro scores for the 252 areas ranged from 100 (Iowa City, IA) to Vineland-Bridgeton, NJ (68.22). Interestingly the categories where Medford scored well below the national average were health care (-25.61% below average), living arrangements (-10.71%) and employment/education (-15.57%). Medford ranked 211th our of 252 cities in the healthcare category.

For health care, Medford had only 3 our of 16 indicators above the national average and these were: number of hospitals with Alzheimer’s units, number of hospitals with hospice services and number of physical therapists. Oddly, Medford ranked 61st among the 252 metro areas in “wellness,” so we must be doing something right.

There are 11 indicators within the living arrangements category and Medford ranked 5th for continuing care facilities and 20th for the percentage of houses with residents 65 or older. However, the number of nursing beds (249th) and number of home health-care providers (190th) resulted in an overall ranking of 202 in this category.

For the average person, wading through all this data is not easy and I must admit I found it tough going at times. What I do believe is that this report should be read and understood by our city and county administrators and perhaps there needs to be a more cohesive strategy developed for how we deal with the burgeoning older adult population. Oh, by the way, Medford did beat out Eugene, which was ranked 196th. No something to brag about however. The larger Best Cities report had Medford ranked 91st out of 179 small metro areas.

We decided to call it a “demonstration” home and this is what that idea looks like in practice. So far this week we have given seven tours of our “certified Lifelong Housing” home to over a dozen people. And we are only at mid-week! One of the tours was to Janet Eastman, well-regarded Oregonian journalist who then wrote an article, with accompanying photos. It’s up on the ‘Oregon Live’ link and will be featured in the Oregonian in February.

Our kids who live at a distance have not seen this new home of ours yet, so they were ecstatic to roll through the slides and commentary. Elisabeth, our oldest daughter, posted her own comment on Facebook. “My parents never slow down…and now they don’t have to.”

We love our convenient, easy living home with its lessened likelihood of having a fall and fracture. The no-step entries and bathroom grab-bars reduce our fall-risk. And if we did fall and break something, we could easily return to a home that had a comfort toilet and a bathroom that accommodated walker or wheelchair.

We are eager to share our home’s “universal design” with people who recognize that as we age we need conveniences like levered handled doors and no-scald showers. But wait!! We probably need those kind of conveniences at any age.Homes that meet the universal design criteria stand the test of time. They assure little things like windows that open with the touch of a finger or a closed fist or big things like the availability of a bathroom that your friend who is in a wheel chair can get into when she comes to visit. The most frequent comment we get from visitors is “Wow, this is beautiful, I thought it would look like a nursing home.”

At some point as people get older they begin to plan for the future. Most often it is a look at their finances and retirement plans. We also begin to think about health and legal issues and may draft an Advanced Directive to indicate our health care preferences and perhaps a Will. There is one other tool that is vital to planning your future…..a tape measure.

Surveys tell us quite clearly that most people plan to stay in their current home as they grow older. Thus a 65 year old might be living in a home built ten, twenty or more years ago that may have undergone some remodeling in the intervening years. However, surveys also indicate most people do not have a plan for staying in their home; what the Centers for Disease Control and Prevent terms “aging-in-place.”

This is where the tape measure comes in. The process of looking at your home through a “ten years in the future” lens will help you understand what modifications might be necessary to remain in your home.

Grab your tape measure and step out your front door. How many steps do you have from the sidewalk, the street or from your driveway? Let’s say you have four steps each five inches high to your front porch. This equals an elevation of 20 inches. Should wheelchair access be needed now or later, at the recommended 12:1 slope (12 inches to one foot) you would need a 20 foot ramp or raised walkway. Is this possible? In our new home we had the advantage of being able to design a meandering concrete walkway from the sidewalk to the porch. Visitors don’t even realize it was intended as a wheelchair ramp. An alternative entry might be through a garage or rear entrance if a suitable scope could be achieved.

Now that you are at the front door, take your tape measure and check the width of your front entrance. If you have less than 32 inch clearance, a wheelchair will likely not fit. Optimum size would be a 36 inch door with a maximum 1/2 inch threshold.

Once you are back in the house, scan the living area. Do you have an open concept floor plan or are the rooms (dining, living and kitchen) confined by walls and halls. If so, you need to get the tape measure out and see if you have 36 inch wide access to these rooms.

Finally, check out your guest bathroom. Again, you want at least a 32 inch entrance door and greater room to navigate either a 60 inch turnaround space or a 30 inch by 48 inch clear space with an entrance door that opens out and not in.

There are numerous other home features you may need as you “age-in-place,” such as grab bars in the bathroom or hard survace floors instead of carpet, but understanding the dimensions discussed are fundamental to planning future modifications to your home.

If you make the tough decision, as we did, to sell our home of 14 years because future access would have been cost-prohibitive, or just because you want to downsize, make certain your next, and perhaps final, home measures up.

Here are the facts. Over the past year, my husband and I have immersed ourselves in educating others about “age-friendly” living and “life-long” housing. We launched a non-profit organization whose name (Age-Friendly Innovators Inc.) shouts our intentions. We built a home using universal design principles and tour people through to demonstrate the easier living that comes with no-step entries and comfort height toilets. We are using multiple forms of media to spread the word.

We have tried to do everything we can to assure people understand and absorb what is needed for aging adults to “age-in-place” in a home of their own. After all–who wants to spend the final years of life in the corner bed of a nursing care facility.

Here is the reality. People are not aging. Differently put, most folks do not see themselves as getting older. Nope. Nada. “Not me…” That makes them resist attempts to talk about the living situation that might be required at age 75 and plan for it. Active denial is epidemic.

I finally “get it.” But how do you deal with an epidemic of denial about getting older? An anti-aging vaccine would have huge receptivity. But there is none. The possibility of developing a substance of any kind that will slow or reverse the biological process of aging is highly unlikely yet retailer’s shelves are packed with expensive, unproven products that try to make the case. You probably have some in your medicine cabinet.

If this is an epidemic of denial and the “cure” is preparation and planning for late in life realities. How do we better make the case?

We are open to ideas. A presidential proclamation about the joys of aging? Huge discounts on purchases to anyone who self-identifies as over age 70? Appointment of an “aging czar” who is 80 years of age but looks and acts decades younger? Ad campaigns that feature actively aging movie stars in their accessible homes?

My husband and I are self-described “social innovators” so we will keep the ideas coming. Now that we “get it” maybe we can make new inroads. May the force be with us. And also with you.

About This Blog

Sharon and Howard Johnson are Certified Aging-in-Place Specialists (CAPS) with the National Association of Home Builders who have launched a nonprofit organization, Age Friendly Innovators Inc. (www.agefriendlyinnovators.org)They are passionate about the importance of older adults aging in place in a home of your own and have practical and provocative ideas about how to make that happen.
Sharon is a retired Oregon State University educator who has developed dozens of award-winning programs about health and aging. She has written a weekly column for the Mail Tribune for over ten years.
Howard is semi-retired from his international work in marine conservation. In 2010 he was named a Purpose Prize Fellow by Encore.org as a "social innovator."